Tom Ahrens, DNS, RN, CCNS*
Research Scientist
Barnes-Jewish Hospital
St. Louis, Missouri, USA

Alexander P. Johnson, RN, MSN, ACNP-BC, CCNS, CCRN**
Critical Care Clinical Nurse Specialist
BroMenn Regional Medical Center
Normal, Illinois, USA

Robert W. Taylor, MD, FCCM***
Clinical Professor and Director
Critical Care Training Program
Saint Louis University
St. John's Mercy Medical Center
St. Louis, Missouri, USA

Families of patients admitted to critical care units in the United States can expect that their loved ones will be cared for with state-of-the-art technology and well-prepared clinicians. However, the care provided to families may be less than ideal. As they enter the critical care environment, many are experiencing the most intensely difficult situations of their lives. Physicians and nurses, as well as other clinicians and support personnel, are so focused on helping the patients, little time is left for families and minimal resources are available. Though materials such as pamphlets and handouts have a role in family education, clinicians may find items to be outdated or limited in their scope.

Fortunately, most families leave the intensive care unit (ICU) with an overall feeling of satisfaction. These satisfaction levels are tied more to the positive clinical outcomes of their loved ones than to their own hospital experience. However, if clinical outcomes aren’t ideal, unsatisfied families can present major challenges to the ICU staff. The situation can lead to lead to lack of trust, hurt feelings and potential lawsuits. In additional, dissatisfied families often leave the ICU with lifelong hardships and trauma.

Families deserve good communication. This communication should be part of an infrastructure and culture that provides consistent, accurate and easily accessible information. Some information can only come from clinicians, such as patient-specific outcome and needs assessments. However, a large amount of the information families need can be obtained through other methods, such as online computer-based information.

Barnes-Jewish Hospital implemented a computer-based waiting room facility in 2001 to aid clinicians in family communication. The waiting room computer was secured and directed only to specific Web sites that provided family-oriented information. Funding was provided by the Barnes-Jewish Foundation through the Auxiliary. The program worked best when clinicians briefed families about the computer upon admission. These families showed great appreciation and many shared the information, showing other waiting families how to use the resource. When families were left on their own and not directed by clinicians to the computer, use declined sharply. These families mostly asked to use the computer to check email or play games.

The public is increasingly oriented to computer and Web-based information, and most age groups can access the Internet. If the hospital does not provide accurate information about a patient’s condition or about the ICU environment, the family likely will obtain the information through potentially unreliable Internet sources.

Online education allows family members to obtain accurate and thorough information at their own convenience. Empowering individuals to find answers to common questions through the computer allows the clinician more time to address patient-specific issues. The waiting room computer also provides a consistent message so that multiple family members visiting at different times do not ask clinicians the same questions.

Computer users should be directed to trusted sources. At Barnes-Jewish Hospital, waiting room computers are pre-programmed to show preferred sites, including the National Library of Medicine (http://medlineplus.gov). MyICUCare.org is a critical care-specific site offered through the Society of Critical Care Medicine. This site offers free ICU Issues & Answers brochures, answers frequently asked questions about critical care and provides a glossary of terms. Clinical information about sepsis, patient and family care and end of life also are available as well as links to other Society resources. In addition to these Web sites, most hospital sites outline frequently asked questions specific to the hospital or area, such as where to eat or sleep.

Family members at Barnes-Jewish Hospital are allowed to have as much access to the computer as desired. Rarely, some visitors will try to download games or access other programs on the computer. These issues are discovered and reported quickly, and no technical problems have surfaced so far as a result of improper use.

Computer-based waiting rooms provide great support for clinicians as they attempt to enhance communication with families. Of course, online information does not replace clinician communication. Families often are desperate to hear from their physicians and nurses regarding their loved one’s specific problems. It is time that hospitals become more sophisticated in helping patients’ families to ensure their satisfaction, and a waiting room computer is a resourceful, reliable tool in this effort.

Disclosures

*Author has disclosed that he is the developer of the ICU-USA. ICU-USA develops and operates a consumer-oriented medical information and education program based on computerized, Internet-based kiosks located in hospitals and educational services provided to hospital staff.

**Author has no disclosures to report.

***Author has no disclosures to report.